Robotic surgery for endometriosis

Abstract

: Endometriosis is an estrogen-dependent, benign, debilitating disease that affects women during the reproductive age. Its clinical behaviour is extremely heterogeneous ranging from an asymptomatic finding to a severe disorder involving multiple extragenital organs and causing symptoms as infertility, dysmenorrhea, or chronic pelvic pain. The first line of treatment should include medical therapy, but when it fails or if the patient does not tolerate it, surgery is often the most effective treatment of endometriosis, and a minimally invasive approach using laparoscopy is considered the gold standard. Robotic surgery has taken more and more space in endometriosis treatment, especially to achieve a safe and radical surgery for deep infiltrating endometriosis (DIE), overcoming the intrinsic technical limitation of conventional laparoscopy thanks to the greater freedom of movements made possible by seven-degree laparoscopic instruments, the magnified and high-definition 3D camera and the tremor filtering. Robotic surgery also allows the real-time visualization of vascular and microvascular flow. Robotic surgery seems to be a safe and feasible technique even in the management of critical condition, as for example obese patients, extragenital endometriosis involving bowel, bladder, ureters, or diaphragm. The injection of indocyanine green (ICG), thanks to the Firefly technique, allows a further improvement in the eradication of DIE.